CREDENTIALING PROVIDER MANUAL

CREDENTIALING PROVIDER MANUAL OCTOBER 31, 2017 ADVANCED BEHAVIORAL HEALTH, INC DCF CREDENTIALING DEPARTMENT 213 COURT ST., MIDDLETOWN, CT 06457

Page 2 TABLE OF CONTENTS Section I: Introduction Page 4 Section II: Program Overview: Credentialing DCF Client Service Providers Page 5 Purpose of this Manual Page 6 Before Services Begin Page 7 Confidentiality Page 7 Non Discrimination Page 7 Provider s Rights Page 8 Section III: Credentialing Page 9 Standards of Participation Requirements Page 9 Credentialing for Service Providers Page 9 Steps in the Credentialing Process Page 10 Guidelines for Providers Applicants Page 11 Organization/Agency Providers Page 12 13 Service Definition & Eligibility Criteria Page 14 After School Services Page 14 Assessment (Diagnostic/Functional) Page 15 Assessment: Perpetrator of Domestic Violence Page 16 CHAP/CHEER Case Management Page 17 Community Based Life Skills Page 18 General Livery Transportation Page 19 School Transportation Page 21 Supervised Visitation Page 22 Temporary Care Page 23 Support Staff Page 24 Therapeutic Support Staff Page 26 Section IV: DCF Guidelines: Provision of Services Page 29 Access to Services Page 29 Billing Requirement Page 29 Region Specific Invoice Submission Guidelines Page 31 Region I: Bridgeport/Norwalk/Stanford Page 31 Region 2: Milford/New Haven Page 31 Region 3: Middletown/Norwich/Willimantic Page 32 Region 4: Hartford/Manchester Page 33 Region 5: Danbury/Torrington/Waterbury Page 33 Region 6: Meriden/New Britain Page 34 Fee Schedule Page 34 35

Page 3 Raising Awareness of Professional Boundaries Page 36 38 Service Data and Reporting Requirements Page 39 Mandated Reporting Page 43 49 Child Passenger Safety Laws in Connecticut Page 50 51 Progress Reports Page 52 Supervision Page 52 53 Documentation and Recordkeeping Page 54 Monitoring and Review Page 55 Section V: Diversity Page 56 Developing a Multi culturally Competent Service System Page 56 Working with Deaf and Hard of Hearing Persons Page 57 Section VI: Re credentialing Page 58 Section VII: DCF Credentialing for Service Providers Policy/ Quality of Service Page 59 Ongoing Monitoring Page 59 Reporting Requirements Page 59 Denial of Credentialed Status Page 60 61 Circumstances Leading to Termination of Staff or Organization Page 62 Provider Termination and Reinstatement Page 62 Transition of Clients Page 63 Appeals Process Page 63 Section VIII: Appendix A. Abbreviations B. DCF Credentialed Provider Documentation Form C. Provider Invoice (Credentialed Service) D. Provider Invoice (Transportation Only) E. Supervision Notes F. DCF Credentialed Provider Review Tool G. Provider Self Assessment Tool

Page 4 Section I: Introduction Dear Provider: Thank you for becoming a Participating Provider! The Department of Children and Families (hereinafter DCF) and Advanced Behavioral Health, Inc. (hereinafter ABH ), is pleased to welcome you. This Provider Manual answers questions you may have about procedures, policies and other facts related to your provision of services and is part of your provider agreement for services through the Department. Updates to any part of this Provider Manual may be made at any time. ABH may give notice of such updates in a variety of ways, depending on the nature of the update, including, but not limited to, issuance of a new manual, a letter, a provider alert, a provider newsletter or by posting to ABH s website.

Page 5 Section II: Program Overview Credentialing DCF Client Service Providers Since July of 2007, the Department of Children and Families has funded ABH for the purpose of obtaining, verifying and assessing the qualifications of potential individuals or organizations that will provide direct client services under the Child Welfare Wrap Around Funding (hereinafter WAF) Program. ABH is responsible for administering the credentialing requirements including accepting and tracking applications from potential service providers, verifying the credentials of potential service providers in accordance with the Department s credentialing criteria, providing technical assistance to and maintaining quality information on service providers. Direct service clients, DCF, and Committed and Voluntary children and youth ages 5 21 are all served by this program. ABH administers the credentialing and quality management of and website directory for the following DCF services: After School Programs, including three (3) separate levels of service depending on the age and needs of the youth for programs not funded by the Connecticut (hereinafter CT) Department of Education nor licensed as a daycare provider under the Department of Connecticut Office of Early Childhood; Assessments; Assessments of Domestic Violence (hereinafter DV) Perpetrators; Case Management services for Community Housing Assistance Program (hereinafter CHAP); Community Based Life Skills (hereinafter CBLS) Program; Supervised Visitation; Support Staff; Temporary Care; Therapeutic Support Staff; Transportation (Exempt from Credentialing: Connecticut Transit Districts and School Transportation operated and provided oversight by School Districts) ABH oversees the credentialing process for providers seeking to enter into provider agreements with the Department of Children and Families for all services including: Developing and distributing applications, using the DCF s definition of eligible programs and credentialing criteria for providers; Receiving all applications and re applications for enrollment as a DCF provider; Reviewing the applications for completeness and accuracy; Conducting verification of an individual specific basis for professional services applicants;

Page 6 Reviewing background information that is submitted with the individual s application including criminal records, Child Protective Services (hereinafter CPS) registry and sex offender registry; Reviewing the Federal Office of the Inspector General s website registry of professional healthcare providers and entities excluded from participation in federal healthcare programs; Serving as a liaison between the Department and the providers and participating as a member of the Credentialing Review Committee (hereinafter CRC); Maintenance of a database with current information on credentialed providers including disposition on pending applications; Tracking the bi annual interval for re credentialing, and sending out the re credentialing application to currently credentialed providers; Receiving and recording complaints regarding provider service quality and performance; Conducting quality site visits to assure the program is offered in a safe and secure setting. Purpose of this Manual This Provider Manual is intended for DCF Credentialed provider(s) delivering direct service(s) to DCF clients. This manual is a legal document incorporated by reference as part of each Provider Service Agreement. This manual serves as an administrative guide outlining the DCF s policies and procedures governing the administration of the DCF services and is an extension of and supplement to the Provider Agreement(s) between DCF and Credentialed Providers, which includes, individual and ancillary providers (organization and staff members). This manual is posted on the ABH website at www.abhct.com. Updates to the manual as permitted by the Provider Service Agreement will be posted on the ABH DCF Credentialing Resource Page and notification may also be sent by postal mail and/or electronic mail. Notification is forwarded to providers at least 60 days prior to the effective date of any policy or procedural change that impacts providers. Website Resources This manual is available on ABH s website at: http://www.abhct.com/news_resources/dcf_credentialing/

Page 7 Before Services Begin All providers are required to be approved by DCF prior to rendering services. Providers will be recredentialed every two years. Credentialing is the process by which the credentials and qualifications of applicants are evaluated and reviewed. It is an important process that ensures that providers have the requisite qualifications and training needed to deliver quality care and service. The credentialing process also ensures the verification and review of individuals with adverse actions against them, such as sanctions, malpractice or fraud. The evaluation includes, but is not limited to: Background Checks; Critical Incidents; Completion of Mandated Reporter Training; Education verification; Postgraduate training; Certifications; Work History and demonstrated ability and Licensure and regulatory compliance Professional Letters of Recommendation. It is expected that each provider will adhere to all standards, laws, and guidelines that are established by federal, state and discipline specific licensing and/or oversight bodies. Each provider is expected to demonstrate the processes used for credentialing staff and ensuring quality of care, following DCF guidelines and standards. Again, minimum standards imposed by the State will be met; however, ABH reserves the right to impose standards above the State minimums in certain instances. Confidentiality Information collected during credentialing is considered confidential and is not discussed with anyone inside or outside of ABH except when required in the normal course of business or as required by law. Proceedings of the Credentialing Review Committee Meetings are also confidential. Non-Discrimination An applicant shall not be denied on the basis of sex, race, age, creed, national origin or disability unrelated to the capability to fulfill the duties and responsibilities of the provider s profession or the provider agreement.

Page 8 Provider s Rights Applicants have the right to review all information in the credentialing file except references or recommendations protected by law from disclosure. Applicants have the right to review information to support their credentialing application; to correct erroneous information; to be informed of the status of their credentialing application upon request. During the credentialing process, if ABH receives information that varies significantly from the information submitted on the application, an opportunity to explain the discrepancy will be provided.

Page 9 Section III: Credentialing Standards of Participation Requirements Your participation is determined by completion and acceptance of your DCF participating provider agreement and credentialing application. To avoid delays in compensation and gaps in participation it is critical that you contact ABH whenever you are adding or deleting an individual from your practice. It is also important that you maintain accuracy of your demographic information as we are relying on this information for the provider directory and to submit to DCF for their claim payment system. Notification of your effective date as well as a provider identification number will be given by DCF upon credentialing approval. Credentialing for Service Providers The Department of Children and Families requires the credentialing of individuals and organizations that provide specific DCF funded services to children and their families. Definitions Credentialing means a formal system whereby individuals and organizations apply to provide specific DCF funded services to children and their families and, upon approval of their applications, enter into a Provider Agreement with DCF. The services are purchased through applicable wraparound services funding. DCF funded services means those services to which children and families involved in current child welfare or juvenile justice cases are referred by DCF social workers and juvenile justice social workers respectively, and those services provided to children and families through ABH who are not current clients of DCF. Credentialing services assures that all individuals and organizations, and their employees, seeking to provide DCF funded services to children and their families are properly screened and have the requisite credentials before having unmonitored access to children. Only providers that have obtained or renewed their credentialing and have executed Provider Agreements with DCF shall be eligible to provide these specific services. The entities responsible for credentialing are: Contracted Agent: The entity with which DCF contracts to assist in managing the application and credentialing process. The current contracted agent is ABH.

Page 10 Applicant: The individual or organization that is applying to obtain or renew credentialing for it and/or for its staff, or is applying to obtain credentialing of prospective employees it is seeking to hire. DCF Credentialing Review Committee: The decision making body within DCF which has the authority to approve, deny or de credential any applicant seeking to obtain or renew credentialing. Steps in the Credentialing Process STEP 1. All applications are posted online. You can download an application by visiting (http://www.abhct.com/news_resources/dcf_credentialing/. An applicant can apply as an individual provider or as an agency. STEP 2. Download the provider agreement for the type of service for which you are applying. Sign and date the last page of the agreement. STEP 3. Complete the application, submit the application, provider agreements and required documentation to: Advanced Behavioral Health DCF Credentialing Department 213 Court St. Middletown, CT 06457 Please make a copy of all documentation submitted for your records. Original signature pages are required. Requirements for all providers: All questions answered on the application; Explanations of any affirmative responses on the malpractice claims history and/or professional review questionnaire; Proof of current liability insurance in required amounts (if applicable); Signed DCF Confidentiality Agreement and Ethics Agreement; Signed and Dated Certification and Authorization Page; Signed and Dated W9; Signed and Dated Provider Agreement. STEP 4. Upon receipt of the application packet, the ABH Credentialing Specialist verifies credentials and prepares applicant s files for review. Written notices will be sent to applicants whose credentials are being reviewed until all required documentation is received by ABH. Inactive applications will be held for 180 days, and then closed for consideration to become a DCF Credentialed Provider. STEP 5. The decision to accept or deny an applicant is based on the recommendation of the DCF Credentialing Review Committee. After the completion of the credentialing process, a timely notification of the credentialing decision is sent to the provider. Approved providers will be listed in

Page 11 the on line provider directory of approved providers (http://app.abhct.com/dcfcredrostersearch.asp). Guidelines for Provider Applicants Individual Providers An individual provider is defined as a sole provider who, as an individual, is understood to assume all risks and liabilities when delivering such service and who provides us with a social security number or tax identification number (TIN) that is associated to their name alone. Credentialing files maintained by individual providers will include; but not be limited to the following: Copy of completed DCF Individual Provider Application Form Copy of signed DCF Confidentiality Statement and Ethics Agreement Copy of all signed Provider Agreements Copy of completed and signed W9 Resume or Curriculum Vitae, with explanations for any gaps in work history of six months or more 3 Professional Letters of Recommendation; Current copy (within 6 months of application) of DCF Child Protective Services background check result (updated every two years) Current copy (within 6 months of application) of DESPP Criminal History background check result (updated every two years) For A Non Clinical Service Provider: (Supervised Visitation, Therapeutic Support Staff, Support Staff, Temporary Care, Community Based Life Skills, Transportation and After School Staff) Current valid Department of Motor Vehicles (hereinafter DMV) license Current motor vehicle insurance Current Cardio-Pulmonary Resuscitation (hereinafter CPR) certification Current First Aid certification Signed Supervisory Agreement (if applicable) Copy of Supervisor s Resume or Curriculum Vitae (if applicable) Current copy (within 6 months of application) of DCF Child Protective Services background check result (updated every two years) Current copy (within 6 months of application) of DESPP Criminal History background check result (updated every two years) For A Clinical Service Provider: (Assessments or Assessment: Perpetrator of Domestic Violence) Completed and signed Professional Review Questionnaire Signed Consent Form for Release of Confidential Disciplinary Records

Page 12 Current Malpractice insurance with coverage limits of $1 million per occurrence and $3 million aggregate Current copy (within 6 months of application) of DCF Child Protective Services background check result (updated every two years) Current copy (within 6 months of application) of DESPP Criminal History background check result (updated every two years) Organization/Agency Providers Group providers or organizations are defined as those who provide us with a tax identification number (TIN) that is associated to either their name as a PC, LLC, Partnership or to a group business name. Credentialing files maintained by agency providers will include; but not be limited to the following: Copy of completed DCF Organization Provider Application Form Copy of signed DCF Confidentiality Statement and Ethics Agreement Current copy of DCF Child Protective Services background check results of all key personnel (updated every two years) Current copy of Department of Emergency Services and Public Protection (hereinafter DESPP) Criminal History background check results of all key personnel (updated every two years) Copy of all signed Provider Agreements Copy of completed and signed W9 Copy of all current State Licenses (if applicable) Copy of all current Accreditations and/or Certifications (if applicable) Copy of current Certificate of General Liability Insurance (if applicable) Copy of current Certificate of Professional Liability Insurance (if applicable) Copy of After School Program Description (if applicable) Copy of signed Supervisory Agreement (if applicable) Copy of Supervisor s resume (if applicable) Staff s credentialing file (see requirements for each service type, service definition & eligibility criteria) Verification of References. Staff Credentialing Files to be maintained by the Organization Providers shall maintain credentialing files for all part time/full time direct service staff (including consultants and subcontracted employees) and supervisory staff. Staff will meet the minimum requirements of the position as described in the provider agreement(s) established by DCF. Providers will maintain the following documentation including but not limited to:

Page 13 Resume/curriculum vitae ** Copy of In Service Trainings Performance Evaluations Copy of completion of Mandated Reporter Training ** For the purpose of evaluating paid work experience, a job that involved direct contact with children is a job such as a position working directly with children or adolescents in the mental health, developmentally disabled, early intervention, children and youth, juvenile justice, education, drug and alcohol, day care or health systems. Time for which an individual received a stipend or payment for work experience obtained for educational credit or required for a college degree or professional license may be included in the calculation of either educational credit or paid work experience, but not both. Current valid DMV license Current motor vehicle insurance Current CPR certification Current First Aid certification Current Malpractice insurance (for those services requiring malpractice insurance) National Practitioner Data Bank check for all licensed personnel Signed supervisory agreement In accordance with contractual requirements with DCF, providers should furnish copies of staff s current licenses or certificates to ABH prior to or concurrent with expiration.

Page 14 Service Definition & Eligibility Criteria: After School Services are site based and provide a range of developmentally appropriate enrichment, socialization and experiential learning opportunities for children and youth in a safe, structured and supervised setting. This service has regularly scheduled hours both before and after the school day and during school vacations which may or may not include the summer vacation period. After School services are multi dimensional; they are not a single sport or single activity service. Transportation is not part of this service and will be paid separately. Drivers are required to meet the standards under credentialed transportation services. Minimum requirements for the positions listed below include all of the items below: Program Administrator or Site Director o Must be at least 21 years of age; o Must possess a Bachelor's Degree in a field related to Human Services (social work, sociology, counseling, child welfare, psychology, marriage and family therapy, education, social services, criminal justice, child care management, child development, family studies or other human services degree); and o Must have a minimum of 2 (two) years experience in after school programming Senior Group Leader or Senior Instructor o Must be a minimum of 20 years of age; o Must possess a Bachelor's Degree; and o Individual must have at least 6 months experience in after school programming Group Leader or Instructor o Must be a minimum of 18 years of age; o Must possess a Bachelor's Degree; and o Must have at least six months experience working with children or have an Associate's Degree or equivalent college experience and a minimum of nine months experience working with children Assistant Group Leaders o Age: Individuals must be a minimum of 16 years of age; and o Possess some level of experience with children and/or youth o o o o ** PLUS ** Current CPR certification Current First Aid certification Valid DCF CPS background check result Valid CT DESPP Criminal History background check result. Service Type and Service Code: o In Home Youth grades 8 12 (776)

Page 15 o Foster Care Youth grades 8 12 (780). Service Rate and Duration: o Only time spent delivering the service is reimbursable; o Maximum of 5 hours per day, 30 hours per week for a 90 day period. The Area Office can approve more than 25 hours of service per week or extend beyond 90 days. o $182 for up to 30 hours per week; o $364 per week for a vacation period (flat weekly rate) All applicants shall provide DCF with documentation of their qualifications and experience to provide the proposed credentialed service. No prospective employee shall be permitted to have contact with children and their families receiving DCF funded services until approved in writing by DCF. Assessment (Diagnostic/Functional) Individuals access a diagnostic/functional assessment when there is a concern that a DCF child or youth on an active DCF case has a mental health and/or a substance abuse issue that requires further evaluation. The assessment includes an initial face to face screening, additional face to face contacts with the individual and collateral contacts with family members, caretakers and other treatment providers to determine the individual s strengths and limitations, to determine functional capacity, to identify natural supports and to develop or review an individualized service plan. Minimum requirements for the position include all of the items below: Individual must be a Connecticut licensed behavioral health practitioner in good standing: o Licensed Professional Counselor o Licensed Clinical Social Worker (Connecticut General Statutes (hereinafter CGS), Chapter 383b) o Licensed Marriage and Family Therapist (CGS, Chapter 383 a) o Licensed Alcohol and Drug Counselor (CGS, Chapter 376b) o Licensed Psychologist (CGS, Chapter 383a) o Licensed and Board Certified/Board Eligible (hereinafter BC/BE) Psychiatrist General Experience o A minimum of three (3) years post graduate experience in children and adolescent behavioral health relevant to the service to be provided. This direct work with children or youth and their families or caregivers must be within five years of submitting this credentialing application. If the General Experience is not within five years of this credentialing application, continuing work in the field of child and adolescent behavioral health that includes ongoing supervision of staff delivering behavioral health services, program development, program management, consultation, and/or advocacy, within the last five years, may be substituted. o Special Experience: A minimum of 2 (two) years experience conducting diagnostic, functional, and/or intake assessments.

Page 16 Insurance o Current certificate of professional liability insurance with coverage limits of $1 million per occurrence and $3 million aggregate. Compliance with all State and discipline specific standards and regulations. Valid DCF CPS background check result Valid CT DESPP Criminal History background check result Service Type and Service Code: Assessment In Home: (596) Assessment Foster Care (610) Service Duration and Rate: Only time delivering the service is reimbursable; Maximum of 12 hours, unless approved by a Program Director or above; Area Office negotiates the rate based on type and intensity of evaluation needed. Guidelines can be found at: contact CT Beacon Health Options at: http://www.ctbhp.com/providers/providers.html. All applicants shall provide DCF with documentation of their qualifications and experience to provide the proposed credentialed service. No prospective employee shall be permitted to have contact with children and their families receiving DCF funded services until approved in writing by DCF. Assessment: Perpetrator of Domestic Violence is an assessment of an adult member of a current active DCF case. The assessment will include a face to face interview(s) with the perpetrator and may include collateral contacts with family members, DCF, the police, court staff, victim advocates, and other involved providers as required. Assessment to identify risk factors, to make treatment recommendations and to develop appropriate and timely interventions to assure the safety and well being of all family members. A screening for substance abuse or dependency and mental health issues shall be completed as part of the assessment. Minimum requirements for the position include all of the items below: Individual must be a Connecticut licensed behavioral health practitioner in good standing: o Licensed Professional Counselor o Licensed Clinical Social Worker (CGS, Chapter 383b) o Licensed Marriage and Family Therapist (CGS, Chapter 383 a) o Licensed Alcohol and Drug Counselor (CGS, Chapter 376b) o Licensed Psychologist (CGS, Chapter 383a) o Licensed and Board Certified/Board Eligible (BC/BE) Psychiatrist

Page 17 OR Possess a Master s Degree or Bachelors Degree in social work, women's issues, psychology, sociology, criminal justice or a related field. General Experience o A minimum of two years experience involving direct work with DV victims or batterers including 150 hours facilitating or co facilitating a batterer intervention group or class or individual work with batterers specific to addressing issues of coercive control. This direct work with victims or batterers must be within five years of submitting this credentialing application. If the direct work experience is not within five years of this credentialing application, a continuing presence and work in the field of DV that may include ongoing supervision of staff delivering DV services, program development, program management, consultation and/or advocacy in the last five years may be substituted. o Special Experience: A minimum of two years experience conducting bio psychosocial intake assessments. Insurance o Current certificate of professional liability insurance with coverage limits of $1 million per occurrence and $3 million aggregate. Compliance with all State and discipline specific standards and regulations. Valid DCF CPS background check result Valid CT DESPP Criminal History background check result Service Type and Service Code: Assessment interview with client, administration of standardized tests or relevant scales, collateral contacts made for the purposes of completing the assessment, review of relevant records, writing the assessment; Ancillary court testimony, participation in DCF treatment or service planning meetings, and Assessment DV (Service Code 640) Service Duration and Rate: Only time delivering the service is reimbursable; 2 to 6 hours face to face, unless approved by a Program Director or above. Rate is $100 per hour (licensed clinician) $80 Per hour (Bachelor s Degree) All applicants shall provide DCF with documentation of their qualifications and experience to provide the proposed credentialed service. No prospective employee shall be permitted to have contact with children and their families receiving DCF funded services until approved in writing by DCF. CHAP/CHEER Case Management is a community based program that provides case management, supervision, educational/vocational support or career development support, and life skills development services, utilizing the DCF approved Life Skills Program, to youth living in a

Page 18 community housing environment. This service is intended for youth who are committed to the Department as abused, neglected and or uncared for at the time of placement into the program or at the youths eighteenth (18) birthday. This case management service is intended as a component of a comprehensive treatment plan. As such, the individual providing this service is expected to collaborate with other service providers toward the implementation of the child s individual treatment plan. Minimum requirements for the position include all of the items below: Individual must be at least 21 years of age. A Bachelor s Degree from an accredited program in an area of human services, which includes, but nay not be limited to the following: social work, sociology, counseling, child welfare, psychology, marriage and family therapy, education, social services, criminal justice, child care management, child development, family studies OR (7) years of experience working with children and youth; Current valid DMV license Current motor vehicle insurance Completion of the Learning Inventory of Skills Training (hereinafter LIST) Valid DMV Driving Record history result Valid DCF CPS background check result Valid CT DESPP Criminal History background check result Service Duration and Rate: Only time spent delivering the service is reimbursable; Twelve months can be extended to a maximum of eighteen months; $30.01 per diem based on 5 hours per week, $42 for additional hours. All applicants shall provide DCF with documentation of their qualifications and experience to provide the proposed credentialed service. No prospective employee shall be permitted to have contact with children and their families receiving DCF funded services until approved in writing by DCF. Community Based Life Skills are a set of skills learned by teaching or by direct experience. These skills are used to handle problems and questions commonly encountered in daily life from adolescence through adulthood. A community based services model focuses on the development and enhancement of the participant s knowledge of essential life skills to promote preparation for adulthood and self sufficiency. Through program design and content, the model goal is to support and maintain a youth s connection with the community as the youth mature.

Page 19 This service, through the use of the LIST assessment tool and experiential learning approaches, provides youth with a set of skills necessary to assist in their transition from DCF care to selfsufficiency. This service includes an individual life skills assessment, followed by individualized and small group experiential learning opportunities. This service is intended as a component of a comprehensive case plan. As such, the individual providing this service is expected to collaborate with other service providers toward the implementation of the child or youth s individual case plan. In order to emphasize consistency and relationship building, it is expected that the same staff person will provide this service continually throughout the course of the service while both the staff person and the youth remain with the program. Any changes in staff must be discussed with and approved by the Department Area Office. Minimum requirements for the position include all of the items below: Individual must be at least 21 years of age. A Bachelor s Degree from an accredited program in an area of human services, which includes, but nay not be limited to the following: social work, sociology, counseling, child welfare, psychology, marriage and family therapy, education, social services, criminal justice, child care management, child development, family studies. Must have successfully completed the LIST training. Must have at least six months of experience performing LIST assessments or facilitating life skills plans with adolescents. Current valid DMV license Current motor vehicle insurance Current CPR certification Current First Aid certification Valid DCF CPS background check result Valid CT DESPP Criminal History background check result All applicants shall provide DCF with documentation of their qualifications and experience to provide the proposed credentialed service. No prospective employee shall be permitted to have contact with children and their families receiving DCF funded services until approved in writing by DCF. General Livery Transportation Transportation services provide general transportation for children and youth when service is not delivered by Department of Children and Families staff, family or caregivers, public transportation or school buses where the child resides. Credentialed transportation services shall NOT be utilized in cases where the child is younger than age five (5), or a child's medical or psychiatric condition requires a highly trained or specialized service such as a medical cab or ambulance. General Livery Transportation does not include school or school related activity.

Page 20 The Provider Agency shall be responsible for full compliance with all relevant Department of Transportation statutes and regulations including C.G.S. 13b 96 1 to 13b 96 51, ("Transportation of Passengers for Hire ), and C.G.S. 16 325 01 to 16 325 26 ("Livery Service"). All Transportation Operators shall be responsible for full compliance with all relevant Department of Motor Vehicle statutes and regulations including C.S.S. 14 44 "Public Passenger Endorsements." All credentialed service rates, excluding After School include the cost of transportation; therefore these services are not eligible for a separate transportation rate. Minimum requirements for the position include all of the items below: Must be a minimum of 18 years of age (21 years of age if driving a commercial motor vehicle); Must have a current DOT Livery Permit; Current valid CT DMV license with an F endorsement; Current CPR certification; Current First Aid certification; Insurance: Proof of current certificate of motor vehicle insurance with the limit of $1.5 million per vehicle coverage is required by the state. Applicants or holders of a public passenger endorsement must have an acceptable driving record. All types of public endorsements are only issued after a fingerprint background check. The DMV monitors and cross checks each of these licenses for a new criminal activity on a monthly basis and if found the license is suspended, the driver s credentialing agreement will be suspended as well. Service Type and Service Code: Transportation Other Foster Care (380) Transportation Other In home (160) Transportation Other JJ (208) Service Rate: Trip charge is pro rated by 15 minutes; there is no minimum hour per trip; A trip begins when the first child is picked up and ends when the last child is dropped off; Fee schedule: o 1 Child = $50 per hour, o 2 Children = $75 o 3 children = $95, o 4 children = $115 Wait Time DCF pays for wait time while the client is at the appointment/activity if the duration of waiting time is less than the time it takes the driver to go back to the office x2 (Roundtrip)

Page 21 The Department does NOT reimburse for No Shows if there is a cancelation by DCF before the provider staff leave the office for the service. If the Department fails to cancel, payment will be made for time spent in travel and waiting for the child. Fuel Charge: The fuel charge is paid at a rate of $.20 cents per mile and will be paid one time regardless of the number of children being transported. It is the responsibility of the organization to ensure all drivers are meeting all Department of Motor Vehicles statutes and regulations Chapter 246 Motor Vehicle: C.G.S 14 100 regarding Seat Safety Belts and Child Restraint Systems. All applicants shall provide DCF with documentation of their qualifications and experience to provide the proposed credentialed service. No prospective employee shall be permitted to have contact with children and their families receiving DCF funded services until approved in writing by DCF. School Transportation provides transportation for children and youth to and from school when the service is not available through the responsible Local Educational Agencies (LEA), family or caregivers, the Department of Children and Families staff, or public transportation. Credentialed transportation services shall NOT be utilized in cases where the child is younger than age five (5) or when a child's medical or psychiatric condition requires a highly trained or specialized service. The Provider shall be responsible for full compliance with all relevant Department of Motor Vehicles statutes and regulations C.G.S. 14 44, including those related to "Public Passenger Endorsements." Minimum requirements for the position include all of the items below: Must be a minimum of 18 years of age (21 years of age if driving a commercial motor vehicle Current valid CT DMV license with the appropriate endorsement for the type of school transportation the driver is applying to provider. Current CPR certification Current First Aid certification Insurance o Proof of current certificate of motor vehicle insurance with the limit of $1.5 million per vehicle coverage is required by the state. Applicants or holders of a public passenger endorsement must have an acceptable driving record. All types of public endorsements are only issued after a fingerprint background check. The DMV monitors and cross checks each of these licenses for a new criminal activity on a monthly basis and if found the license is suspended, the driver s credentialing agreement will be suspended as well. Service Type and Code: School of origin transportation for Foster care (643)

Page 22 Service Rate: Trip charge is pro rated by 15 minutes; there is no minimum hour per trip; A trip begins when the first child is picked up and ends when the last child is dropped off; Fee schedule: o 1 Child = $60 per hour, o 2 Children = $85, o 3 children = $105, o 4 children = $125 Wait Time DCF pays for wait time while the client is at the appointment/activity if the duration of waiting time is less than the time it takes the driver to go back to the office x2 (Roundtrip) The Department does NOT reimburse for No Shows if there is a cancelation by DCF before the provider staff leave the office for the service. If the Department fails to cancel, payment will be made for time spent in travel and waiting for the child. Fuel Charge: The fuel charge is paid at a rate of $.20 cents per mile and will be paid one time regardless of the number of children being transported. It is the responsibility of the organization to assure all drivers are meeting all Department of Motor Vehicles statutes and regulations Chapter 246 Motor Vehicle: C.G.S 14 100 regarding Seat Safety Belts and Child Restraint Systems. All applicants shall provide DCF with documentation of their qualifications and experience to provide the proposed credentialed service. No prospective employee shall be permitted to have contact with children and their families receiving DCF funded services until approved in writing by DCF. Supervised Visitation is a service to facilitate visitation between children or youth in out of home care and their biological parents, relatives or other significant people in their lives. This service is primarily a site based service. Whenever possible and appropriate, the supervised visitation can occur in an alternative, more normalized community setting as part of the reunification plan. The provider is required to monitor this contact and to report on the contact in writing to DCF social workers. All sites must be approved by the local DCF Area Office. Minimum requirements for the position include all of the items below: Individual must be at least 21 years of age. A Bachelor s Degree from an accredited program in Child Development, Human Services or other related field.

Page 23 Possess a level of experience consistent with the age and needs of the children or youth involved in the visitation. Current valid DMV license Current motor vehicle insurance Current CPR certification Current First Aid certification Valid DCF CPS background check result Valid CT DESPP Criminal History background check result Transportation for Supervised Visitation Service: The hourly rate for this service includes transportation. The service reimbursement starts when the child(ren) is present in the car and is reimbursed at the service rate. Mileage reimbursement when a child(ren) are not in the car will be paid only after the first 20 miles each way; (Example: if the total distance to pick up/drop off one way is 25 miles. Reimbursement will be for 5 miles each way, a total of 10 miles for the roundtrip.) Mileage reimbursement must be pre approved Reimbursement rate is the current federal service rate The Department does not reimburse for No Shows if there is a cancellation by DCF before the provider staff leave the office for the service. If the Department fails to cancel, payment will be made for the time spent in travel and waiting for the family. Service Type: Supervised visitation Foster care (613) Service Rate and Duration: Fee Schedule is $45 per hour Only time spent delivering the service is reimbursable; Supervision of staff must occur at a minimum of 15 minutes per Child or Youth per month; o Supervision must be face to face with a licensed behavioral health practitioner in good standing; o A clinical consultant to the organization can provide the supervision; o Supervision may occur in an individual or group setting. Duration of the supervised visitation contract is a maximum of 25 hours or 60 days whichever comes first. This rate includes all of the children in the home. All applicants shall provide DCF with documentation of their qualifications and experience to provide the proposed credentialed service. No prospective employee shall be permitted to have contact with children and their families receiving DCF funded services until approved in writing by DCF. Temporary Care provides a short term break or intervention, separating the child/youth from caregivers for a few hours, or other relatively short period of time in order to assist family members with the practicalities of living and their attending to the needs of all family members. This service is provided in the home of the parent or caretaker.

Page 24 Minimum requirements for the position include all of the items below: Individual must be at least 21 years of age. Age must be verified by a birth certificate or current motor vehicle license; Must possess a level of experience consistent with the age and needs of the child or youth; Valid DCF CPS (Child Protective Services) background check result; Valid CT DESPP Criminal History background check result. Service Type and Service Code Temporary Care Service In Home (294) Temporary Care Service Foster Care (372) Service Duration and Rate: Only time spent delivering services is reimbursable; The duration of Temporary Care is a maximum of 45 hours or 90 days whichever comes first o The rate covers up to 3 children in the home; Service rate is $24 per hour; o This service is NOT to exceed $200 per day. All applicants shall provide DCF with documentation of their qualifications and experience to provide the proposed credentialed service. No prospective employee shall be permitted to have contact with children and their families receiving DCF funded services until approved in writing by DCF. Support Staff is a service designed to address the individualized needs of a child or youth in the community who may be exhibiting mild to moderately challenging behaviors in the home, in school or in the community. This service provides a range of supports focused on making positive decisions and behavioral choices; assisting with attaining social and emotional gains; connecting with positive peer and other community supports and reinforcing success in school. These individualized supports are provided by paid, trained and supervised individuals. This service is provided for up to five (5) hours per week per child or youth and includes a combination of structured and enrichment activities consistent with identified treatment plan objectives. In order to emphasize consistency and relationship building, it is expected that the same staff person will continually provide this service during the course of care.

Page 25 This service is intended as a component of a comprehensive treatment plan. As such, the individual providing this service is expected to collaborate with DCF and other service providers toward the implementation of the child s or youth s individual treatment plan. Minimum requirements for the position include all of the items below: Individual must be at least 21 years of age. Must possess at least 3 years of paid work experience consistent with the age and needs of the child or youth. Current valid DMV license Current motor vehicle insurance Current CPR certification Current First Aid certification Valid DCF CPS background check result Valid CT DESPP Criminal History background check result Transportation for Support Staff Services: The hourly rate for this service includes transportation. The service reimbursement starts when the child is present in the car and is reimbursed at the service rate. Mileage reimbursement when a child is not in the car will be paid only after the first 20 miles each way; (Example: if the total distance to pick up/drop off one way is 25 miles. Reimbursement will be for 5 miles each way, a total of 10 miles for the roundtrip.) Mileage reimbursement must be pre approved by DCF Reimbursement rate is the current federal service rate The Department does not reimburse for No Shows if there is a cancellation by DCF before the provider staff leave the office for the service. If the Department fails to cancel, payment will be made for the time spent in travel and waiting for the family. Service Type and Service Code: Support Staff In home (620) Support Staff Foster care (621) Service Rate and Duration: The duration of Support Staff Services is a maximum of 5 hours per week up to 6 months. o The area office may approve more than 5 hours of service per week or an extension beyond the 26 weeks based on case plan goals and objectives. Support Staff Services should not begin until the WAF is approved by DCF; Only time spent delivering the service is reimbursable; Fee Schedule $35 per hour. Supervision of staff must occur at a minimum of 15 minutes per Child or Youth per month; o Supervision is included in the total time authorized for SS o Supervision must be face to face or skype with a licensed behavioral health practitioner in good standing; o A clinical consultant to the organization can provide the supervision;

Page 26 Supervision: of employees is billable at 15 minute increments per staff, per case, per month. Reimbursement for supervision is included in the total time authorized for SS for the child/youth; Documentation Providers are expected to maintain documentation of each SS encounter with the child or youth assigned. Documentation shall be submitted on the attached form, see appendix B. Each encounter will include date, time where the activity took place and the goals of the meeting. The data form must be submitted with the corresponding invoice. All applicants shall provide DCF with documentation of their qualifications and experience to provide the proposed credentialed service. No prospective employee shall be permitted to have contact with children and their families receiving DCF funded services until approved in writing by DCF. Therapeutic Support Staff: (hereinafter TSS) is a service designed to address the individualized needs of a child or youth with complex behavioral health issues. These children or youth have a current diagnosable behavioral health condition that results in moderate to acute functional impairment which substantially interferes with, or limits the child s or youth s role or functioning in family, school, or community activities. This service is intended for children or youth whose level of functioning puts them at risk of entering a residential level of care, disrupting from their home or foster placement, or for children or youth who are being discharged from residential treatment or a more acute level of care. These individualized supports are provided by paid, trained and supervised individuals. This service is provided for up to eight (8) hours per week per child or youth and includes a combination of structured and enrichment activities consistent with identified treatment plan objectives. For children or youth discharging from residential treatment/congregate care, the service is provided for up to two (2) visits for no more than one (1) hour per visit prior to discharge. In order to emphasize consistency and relationship building, it is expected that the same staff person will continually provide this service during the course of care. This service is intended as a component of a comprehensive treatment plan. As such, the individual providing this service is expected to collaborate with other service providers toward the implementation of the child s individual treatment plan. Minimum requirements for the position include all of the items below: Individual must be at least 21 years of age.